Altra

Childish, at the very least. If you ask me to change an assignment, the reason better be related to the patient and/or family.

Health care is a highly regulated industry, and its administration is highly political. HouTx has excellent suggestions above about the nitty gritty actual work of the political process. Some homework for you: do legislatively-mandated staffing ratios necessarily have to be state-by-state, or are there proposed federal bills that aim to do just that?

Great satire ... if only!

Too much being made of nothing. I thought about this for a minute, and can name people in all roles up and down the payscale in my department who use this phrasing: when the unit clerk calls us "my nurses" ... when we refer to "our residents" ... etc. It speaks to the underlying team culture.

Proud 21st century diploma grad here. I have since completed my BSN.

Awesome. Thanks for reviving a great thread.

I have followed this thread with interest. The 2 Level I trauma centers where I have worked both have a dedicated trauma assignment every shift ... but this assignment is rotated among all department RNs who have been in the dept. > 1 year. I believe that setting up the trauma RN as a separate job title would cause significant animosity where I work. Non-trauma ED staff may well resent that they too maintain all competencies, but are designated as the "B team". I would also foresee jockeying for the "better" of 2 simultaneous traumas: "you take the routine unrestrained MVA with questionable loss of consciousness ... I'll take the GSW to the chest". And if I am reading the proposal correctly, these trauma RNs will float throughout the dept. when possible, but will not ever slog their way through 12 hours of abdominal pain or vag bleeding. Pretty sweet!

It's totally not for me to dictate what size bag someone brings to/from work ... but I'm having a hard time picturing "educational resources" that I would be responsible to lug back & forth with me every day. References on gtts & IV meds? Should be easily, quickly accessible in either binder or electronic form. Educational materials? If there are references that are considered the "gold standard" in line with your policies ... shouldn't they be accessible to all? Eye charts?? Is this ED not equipped with a Snellen chart? Leaving personal belongings in a group work environment is a recipe for a mishap.

Are these fluids being ordered after labs have been resulted? The above responses have given a variety of reasons why fluids might be given during a work up, until we have lab evidence of a lack of anything actually clinically wrong with the patient. But if fluids are being ordered after lab results ... I'm inclined to think this is more about a customer-service driven desire to appear to have "done something". And apparently your management is ok with the resulting drag on throughput times.

Ruby Vee makes an important point above - the standing for long periods of time is what will dictate your shoe choice in the long run. The floors of hospitals and other care facilities are typically some kind of tile over a concrete subfloor - it's just the way large buildings are constructed, and it can be very hard on the body over time. White is simply traditional in the US. Some schools require it, some do not. I would bet money that whatever shoes you wear while in nursing school are unlikely to be worn for more than a few months into your nursing career anyway.

OP has given some indication that some of her clinic's patients have been at the hospital for other appointments by the time they arrive at her particular clinic to be seen. I also work at a large tertiary care hospital with virtually every specialty and subspecialty represented in our attached professional office buildings. Overall, the patient population trends toward the elderly and those with multiple comorbidities. During the week -- daily, yes, daily, we get ER patients who initially arrived somewhere on the hospital campus but are now in the ER with syncope, near syncope, generalized weakness ... etc. Not to mention those wheeled down from whatever outpatient office because they "arrived looking like s**t and will probably need to be admitted". So I can definitely visualize the issue that the OP raises. Many patients have transportation issues as well. I can easily picture a scenario in which patient goes to Internal Med clinic but mentions that they have not followed up with Opthamology Surgeon clinic since their procedure and Internal Med staff try to facilitate the patient seeing Opthamology "while they're here in the building" ... and Opthamology agreeing to squeeze the patient in later in the afternoon. Nothing like 4+ hours of shuttling around different clinic offices and diagnostic departments to tax an elderly, infirm patient ... Just saying -- many patients receiving care in outpatient settings do not exactly resemble those smiling, energetic folks pictured in my hospital system's advertising ... But back to the OP ... you've gotten some great info here which hopefully helps alleviate your concerns about responsibility for your patients once they leave your clinic. To improve further discussion, please help us understand exactly what is occurring, and steps you and others have taken / are taking. Thank you.

OP, it has been hard to follow some of your posts. Are you saying that: 1. You have been the staff member to raise concern about medically fragile patients in your clinic? 2. Clinic management is re-evaluating the practice of providers continuing to see patients late in the day without nurses present? 3. This re-evaluation has been ongoing for the last month but no formal decisions have yet been made? We don't work where you do, OP. Help us out - fill in the blanks. It will make for better discussion.

So, this means that you have read detailed case studies of these nurses, including their social histories and been able to conclude that on the job exposure, of which they do not have a clear memory, is the most likely source of their infection? Some reading for you: http://www.cdc.gov/hiv/resources/factsheets/pdf/hcw.pdf Of note -- no cases of HIV transmission to healthcare workers have been documented in the US since 1999.

We must be reading the OP differently, because I am not sensing this kind of self-aggrandizement in the OP's posts. What I am reading, is a disproportionate worry about leaving the clinic at the end of the workday when there are still patients being seen. IMO, in an effort to explain her discomfort with this practice, OP has offered up a number of increasingly unlikely "what if" scenarios to justify her worry. Bottom line OP -- you now work in an outpatient setting. If you believe a patient is at risk of a medical emergency, you, one of your providers, or anyone else in the outpatient setting bears the same one responsibility -- to activate emergency response. That's it. I suggest the following: 1. OP should clarify expectations of her work schedule 2. OP should ask for clarification of the clinic's operations regarding division of duties for nurses and providers 3. OP should ask a preceptor, charge nurse, manager, etc. for some advice and perspective on outpatient care vs. inpatient care, and the differences between them.

Understood. You are correct that medical response to those occurrences is the responsibility of the hospital, if the individuals are on hospital property at the time. However, do not infer that to mean that the clinic, or you personally, are responsible. The medical response team will do their job and respond and obtain the appropriate continuing care for the patient. I sense some worry on your posts that it will be judged that you personally somehow failed to rescue a patient ... and I think that is a big, big stretch for an outpatient opthamology clinic that may not even obtain vitals in the course of a typical office visit.